As a result of overdistention during childbirth, infection or other trauma, damage to the female pelvic anatomy may occur, manifesting in vaginal prolapse, or in less severe instance, in either cystocele or rectocele, or their combination. Cystocele results when the bladder herniates into the anterior vaginal wall. Similarly, rectocele results when the rectum herniates into the posterior vaginal wall.
The vagina lies between the rectum and the bladder. Normally, there are planes of cleavage or potential spaces occurring between the vagina and these structures whereby the vagina, the rectum and the bladder may function and move independently of one another. The potential space between the bladder and the vagina is denoted the vesicovaginal space whereas the potential space between the vagina and the rectum is denoted the rectovaginal space. These "spaces" are generally filled with adipose tissue, providing little connectivity so that the structures are relatively independent of one another.
Both cystocele and rectocele are often accompanied by "loss" of the vesicovaginal space or the rectovaginal space, or their combination. Such "loss" is manifested in an increase of adhesions between the adjacent structures, often holding them in an unnatural anatomical position. For example, a symptom of cystocele is an unnatural protrusion or bulge of the anterior vaginal wall that is aggravated by gravity and accompanied by urinary incontinence. Because of these adhesions within these spaces, impaired or potential mobility of one related structure necessarily involves the adjacent structure, and independent function is compromised. Therefore, any surgical repair tending to return the pelvic anatomy to normalcy advantageously includes restoration of independent mobility of these fused structures. This can usually be accomplished, at least in part, by dissection of the adhesions within these pelvic spaces.
Release of these adhesions through conventional colporrhaphy entails extensive incisions within the vagina, followed by manual dissection to the anatomic limits of the spaces. (see, e.g., Mastery of Surgery, 2.sup.nd Ed., Vol. II, pp. 1532-1549). This approach is tedious, requires cautery to control bleeding, and causes extensive trauma to tissue adjacent to the spaces, which may result in additional subsequent adhesions. Thus there is a need in the art for improved methods of dissecting the vesicovaginal and rectovaginal spaces which reduce trauma to the patient and are less time consuming.
Compared to manual dissection, a less traumatic form of dissection is that accomplished by inflation of a balloon. Balloon dissection is blunt by nature, and tends to minimize bleeding, particularly if the balloon is left in place briefly after inflation as a tamponade. Additionally, the balloon will tend naturally to find the extremes of the anatomic space. Thus, balloon dissection of the vesicovaginal space (VVS) and rectovaginal space (RVS) will provide a less traumatic form of dissection. In, e.g., U.S. Pat. Nos. 5,496,345, 5,814,060, and 5,514,153, a variety of balloon dissection apparatus and methods of surgical procedures using such apparatus are disclosed, which disclosures are hereby incorporated by reference. Despite the advances disclosed by these references, a need exists for a balloon dissection apparatus adapted for dissecting the VVS and RVS, particularly wherein the balloon dissection apparatus enters these spaces through an incision within the vagina.